How to improve the safety of bicortical pedicle screw insertion in the thoracolumbar vertebrae: analysis base on three-dimensional CT reconstruction of patients in the prone position

Abstract Background: Through the comparison of three-dimensional CT reconstruction between the supine position and the prone position, the relative position of thoracolumbar great vessels and vertebral body was studied, and the shortest safe distance between them was measured to improve the safety of bicortical pedicle screw insertion and reduce the risk of vascular injury. Methods: Forty adults were selected to participate the research. Three-dimensional reconstruction of thoracolumbar (T9-L3) CT was performed in the prone position and the supine position. The relative distance between the Aorta/Inferior Vena Cava (IVC) and vertebral body was obtained as AVD/VVD respectively. The relative angle of the Aorta/ IVC and the vertebral body was calculated as ∠AOY/∠VOY. Self-controlled experiments were carried out in the prone and the supine positions, and the data obtained were analyzed using SPSS 22.0 statistical software. Results: The AVD of the prone position and the supine position was the shortest at T12 (3.18 ±0.68mm), but the difference was not statistically significant. The aorta of the T9-L3 segment was shifted from the anterolateral to the anteromedial. The ∠AOY of the other groups differed significantly between the prone and supine positions in all vertebrae except L1 (P < 0.05), and the aorta in the prone position was more anteromedial than that of supine position. With regard to VVD/∠VOY, there was no significant difference between the prone and supine positions (P≥0.05), and the minimum VVD of L3 segment is greater than 5.4mm. The IVC has no obvious mobility and is fixed in the range of 20 °~ 30 ° near the midline. Conclusion: When using bicortical anchoring of pedicle screws, it is safe to ensure that the protruding tips of the screw is less than 3mm. Due to the mobility of the aorta in different postures and individual differences in anatomy, the prone position CT can help doctors to make better preoperative plans and decisions.

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How to improve the safety of bicortical pedicle screw insertion in the thoracolumbar veterbrae with osteoporotic: Analysis base on three-dimensional CT reconstruction of patients in prone position

10.21203/rs.2.19695/v1 ◽

2019 ◽

Author(s):

Chao Xu ◽

Qingxian Hou ◽

Yanchen Chu ◽

Xiuling Huang ◽

Wenjiu Yang ◽

...

Keyword(s):

Pedicle Screw ◽

Prone Position ◽

Vertebral Body ◽

Supine Position ◽

Relative Position ◽

Three Dimensional ◽

Ct Reconstruction ◽

Screw Insertion ◽

Dimensional Reconstruction ◽

Great Vessels

Abstract Background: Three-dimensional CT reconstruction of prone position could measure the relative position between the Great vessels and the thoracolumbar vertebrae. The Great vessels positions of the thoracic and lumbar segments were studied to improve the accuracy of pedicle screw insertion, reduce the risk of vascular injury. Methods: Twenty-four adults participated in the present study. Three-dimensional reconstruction of thoracolumbar (T9–L3) CT was performed in the prone and supine positions. The relative distance between the arteriovenous vessels and vertebrae distance (AVD/VVD) was obtained, respectively. The relative position angle of the arteriovenous vessel and the vertebral body was calculated as ∠AOY/∠VOY. Self-controlled experiments were carried out in the prone and supine positions. The data obtained were analyzed using SPSS 22.0 statistical software. Results: With regard to AVD, The AVD of the T12 was the smallest,> 3.2 mm. The difference among the T9, T10, L2 level was statistically significant (P < 0.05). And AVD was greater in the prone position than in the supine position; while the value of ∠AOY is the descending from T9-L3 gradually, there were statistically significant differences in ∠AOY between T9-T12, L2 and L3 in prone and supine position (P < 0.05). The aorta in the prone position was closer to the midline than that of the supine position, varying from 0°to 30°near the Y axis. With regard to VVD, there was no significant difference in contrast between the prone and supine positions (P≥0.05), and the VVD was the smallest in the L3 level> 5.4 mm. Conclusion: The pre-vertebral position of the aorta may change from T9 to L3 due to changes in body position. When the T9-L3 thoracolumbar spine disease was treated with pedicle screw double cortical fixation, the screw was safe and reliable within a range of≤ 3 mm when broken the pre-cortex .The three-dimensional reconstruction of prone position CT could be used to more accurately assess the relative position of the vertebral body and the blood vessel.

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Preparation of individualized navigation templates for pedicle screw insertion in goats using a three-dimensional printing forming technique

Academic Journal of Second Military Medical University ◽

10.3724/sp.j.1008.2014.00992 ◽

2014 ◽

Vol 35 (9) ◽

pp. 992

Author(s):

Xuan HUANG ◽

Yi-feng WANG ◽

Feng-ning LI ◽

Fan ZHANG ◽

Kun WANG ◽

...

Keyword(s):

Pedicle Screw ◽

Three Dimensional ◽

Three Dimensional Printing ◽

Screw Insertion ◽

Pedicle Screw Insertion ◽

Dimensional Printing

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Routine spinal navigation for thoraco–lumbar pedicle screw insertion using the O-arm three-dimensional imaging system improves placement accuracy

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2013.02.034 ◽

2014 ◽

Vol 21 (3) ◽

pp. 493-498 ◽

Cited By ~ 32

Author(s):

Ji Min Ling ◽

Shree Kumar Dinesh ◽

Boon Chuan Pang ◽

Min Wei Chen ◽

Heng Lip Lim ◽

...

Keyword(s):

Pedicle Screw ◽

Imaging System ◽

Three Dimensional ◽

Three Dimensional Imaging ◽

Screw Insertion ◽

Pedicle Screw Insertion ◽

Spinal Navigation ◽

Placement Accuracy ◽

Lumbar Pedicle

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Comparing Cortical Bone Trajectories for Pedicle Screw Insertion using Robotic Guidance and Three-Dimensional Computed Tomography Navigation

World Neurosurgery ◽

10.1016/j.wneu.2020.05.257 ◽

2020 ◽

Vol 141 ◽

pp. e625-e632 ◽

Cited By ~ 1

Author(s):

Asham Khan ◽

Kyungduk Rho ◽

Jennifer Z. Mao ◽

Timothy E. O’Connor ◽

Justice O. Agyei ◽

...

Keyword(s):

Computed Tomography ◽

Cortical Bone ◽

Pedicle Screw ◽

Three Dimensional ◽

Screw Insertion ◽

Pedicle Screw Insertion

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Augmented reality–assisted pedicle screw insertion: a cadaveric proof-of-concept study

Journal of Neurosurgery Spine ◽

10.3171/2018.12.spine181142 ◽

2019 ◽

Vol 31 (1) ◽

pp. 139-146 ◽

Cited By ~ 11

Author(s):

Camilo A. Molina ◽

Nicholas Theodore ◽

A. Karim Ahmed ◽

Erick M. Westbroek ◽

Yigal Mirovsky ◽

...

Keyword(s):

Augmented Reality ◽

Pedicle Screw ◽

User Experience ◽

Pedicle Screws ◽

Screw Insertion ◽

Pedicle Screw Insertion ◽

Insertion Method ◽

Comparative Accuracy ◽

Placement Accuracy ◽

Surgical Field

OBJECTIVEAugmented reality (AR) is a novel technology that has the potential to increase the technical feasibility, accuracy, and safety of conventional manual and robotic computer-navigated pedicle insertion methods. Visual data are directly projected to the operator’s retina and overlaid onto the surgical field, thereby removing the requirement to shift attention to a remote display. The objective of this study was to assess the comparative accuracy of AR-assisted pedicle screw insertion in comparison to conventional pedicle screw insertion methods.METHODSFive cadaveric male torsos were instrumented bilaterally from T6 to L5 for a total of 120 inserted pedicle screws. Postprocedural CT scans were obtained, and screw insertion accuracy was graded by 2 independent neuroradiologists using both the Gertzbein scale (GS) and a combination of that scale and the Heary classification, referred to in this paper as the Heary-Gertzbein scale (HGS). Non-inferiority analysis was performed, comparing the accuracy to freehand, manual computer-navigated, and robotics-assisted computer-navigated insertion accuracy rates reported in the literature. User experience analysis was conducted via a user experience questionnaire filled out by operators after the procedures.RESULTSThe overall screw placement accuracy achieved with the AR system was 96.7% based on the HGS and 94.6% based on the GS. Insertion accuracy was non-inferior to accuracy reported for manual computer-navigated pedicle insertion based on both the GS and the HGS scores. When compared to accuracy reported for robotics-assisted computer-navigated insertion, accuracy achieved with the AR system was found to be non-inferior when assessed with the GS, but superior when assessed with the HGS. Last, accuracy results achieved with the AR system were found to be superior to results obtained with freehand insertion based on both the HGS and the GS scores. Accuracy results were not found to be inferior in any comparison. User experience analysis yielded “excellent” usability classification.CONCLUSIONSAR-assisted pedicle screw insertion is a technically feasible and accurate insertion method.

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